Individual
DR. JERRY L NEELY
Active
Individual
DR. JERRY L NEELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2797
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0311200
—
OH
01
—
310824134031
CARESOURCE
OH
01
—
NE0403232
MEDICARE LEGACY NUMBER
OH
Enumeration date
01/18/2007
Last updated
08/02/2011
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